Provider Demographics
NPI:1760110852
Name:ALLEN, FELICIA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 BLACK CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9742
Mailing Address - Country:US
Mailing Address - Phone:910-538-6038
Mailing Address - Fax:
Practice Address - Street 1:9005 BLACK CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9742
Practice Address - Country:US
Practice Address - Phone:910-538-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1744P3200XOtherTRICARE , BLUE CROS BLUE SHIELDS, CIGNA DPPO
NC335E00000XOtherPROSTHETIC/ORTHOTIC SUPPLIER
NC335E00000XOtherTRICARE BLUR CROSS BLUE SHEILDS